颈椎后凸畸形的临床特征和外科治疗策略

The clinical features and surgical treatment strategies of cervical kyphosis

目的分析颈椎后凸畸形的临床特征和治疗策略。方法自2006年3月至2009年10月治疗颈椎后凸畸形31例。根据患者的临床特点和影像学表现对其采用不同的治疗方法。手术组9例：男性4例，女性5例，年龄17～72岁，平均35岁；其中继发性后凸畸形4例，特发性颈椎后凸畸形5例。保守治疗组22例：男性11例，女性11例，年龄14～40岁，平均29岁，均为特发性颈椎后凸畸形。手术组：术前及术后1周，按美国脊髓损伤协会的脊髓损伤神经分级标准（AISA）对患者进行评估，术后定期复查颈椎正侧位X线片，并在手术后1周及之后每6个月复查1次颈椎MRI，以评估患者矫形、融合效果及脊髓减压情况。保守治疗组：每个月拍摄颈椎正侧位X线片评估治疗效果。分析此类患者的临床特征及治疗策略。结果手术组：术后3d颈椎侧位片示：Cobb角平均-1．3°（术前54．2°），AISA评分神经功能明显改善，随访时间6～18个月，未见内固定和融合失败。保守组：治疗后4个月Cobb角平均-5．4°（治疗前11．2°），颈项肩背痛症状基本消失，随访3～24个月未见症状复发。结论早期采用体位疗法、石膏支具纠正颈椎生物力学的失衡可以阻止颈椎后凸畸形的发展。根据患者的临床特征，采用个性化的治疗方案，能够充分矫正严重的颈椎后凸畸形。

Objective To analyze the clinical characteristics and the surgical treatment strategy of cervical kyphosis. Methods From March 2006 to October 2009, 31 cases of cervical kyphosis were treated. According to the clinical features and imaging findings, different treatment methods were used. There were 9 patients in operation group,including 4 male and 5 female patients, aged from 17 to 72 years （average age of 35 years）. Among them, 5 cases were idiopathic kyphosis and 4 cases were caused by laminectomy or other reasons. There were 22 patients in conservative treatment group,including 11 male and 11 female patients, aged from 14 to 40 years （ average age of 29 years ） , who were all idiopathic cervical kyphosis. Before and 1 week after operation, clinical assessment were taken for the patients in operation group using Spinal Cord Injuries Classification Standard of American Spinal Injury Association （AISA）. During the periodic review, the anteroposterior, normal sagittal films of cervical spine were taken. At 1 week and every 6 months after operation, MRI films were also taken. These films were studied to evaluate the effects of the opertations. In the conservative group, assessment of treatment results by studying anteroposterior and normal lateral views of cervical spine were were taken every month. The clinical characteristics and the surgical treatment strategies of these patients were analyzed. Results In operation group, 9 cases were followed up for 6 to 18 months, all patients did not failed in internal fixation and fusion. AISA neurological score and neurological function significantly improved. Three days after operation the average Cobb angle was - 1. 29° （preoperative 54. 24 °）. In conservative group, the average Cobb angle was -5.41 ° （before treatment 11.20 °） 4 months after the treatment. The symptoms of neck shoulder and back pain disappeared, and all patients were followed up for 3 to 24 months, with no recurrence of symptoms. Conclusions In the early period of cervical kyphosis, adopt postural therapy, plaster braces to correct an imbalance in cervical spine biomechanics can prevent deformity development. According to patients＇ clinical characteristics, choosing individual treatment programs can correct the severe cervical kyphosis and achieve good outcome.